Table 1.

First-hit/Second-hit Planning Matrix for Communicating Developmental Origins of Health and Disease (DOHaD) With Broad Audiences^*

	Host	Agent	Environment (Place) – Examples
	Individual	Nutritional, Physical, and Social Stress	Home	School	Workplace	Community	Society
Pre-gestation (1st Hit)	Developing girl through woman of reproductive age	Nutrient flow, toxic exposures, and cortisol levels affecting reproductive environment of future mother	Safe, toxicant-free, secure housing Economic security Healthy food preparation facilities and skills Family support for healthy eating and physical activity Adherence to immunization schedules	Safe, toxicant-free school facilities Healthy food vending and service policies Health, nutrition, and physical education	Safe, toxicant-free workplaces Living wage Health insurance Paid sick time Healthy, affordable cafeteria & food storage options Worksite health promotion and injury prevention programs	Safety regulations and enforcement Health, safety, and social services Grocery store zoning Community health centers Neighborhood associations Park development and	Programs and subsidies for community development Equitable economic and social opportunity Non discriminatory educational, housing, and employment practices Accessible quality health care for all Healthy food systems Immunization policies Regulated food pricing, accessibility, marketing Social norms that value equity and inclusion Social norms that value women and girls
Intrauterine /First 1000 days post-conception (1st Hit)	Pregnant woman and other family members Developing fetus Male or female child to age 2	Nutrient flow, toxic exposures, and cortisol levels affecting development of offspring’s organ systems	Safe, toxicant-free, secure housing Economic security Healthy food preparation facilities and skills Breastfeeding support in household Social support Adherence to immunization schedules	Safe, toxicant-free child care facilities Quality, affordable child care services Affordable, quality early childhood development programming Skilled early childhood educators Healthy food service programs in child care Safe recreational facilities for young children	Safe, toxicant-free workplaces Living wage Health insurance Paid family leave Flexible work time Breastfeeding policies and facilities Healthy, affordable cafeteria Onsite child care facilities	Safety regulations and enforcement Quality prenatal and pediatric health care Grocery store zoning Breastfeeding support policies and facilities Skilled nutritional support during pregnancy Community-based early childhood recreational programs
Later childhood through adulthood (2nd Hit)	Developing male or female who has already experienced 1st hit exposures	Nutrient flow, toxic exposures, and cortisol levels compounding and activating initial disease vulnerability	Safe, toxicant-free, secure housing Economic security Healthy food preparation facilities and skills Family support for healthy eating and physical activity	Safe, toxicant-free school facilities Quality PreK-20 education Health, nutrition, and physical education programs Safe, accessible recreational facilities Healthy food vending and service policies	Safe, toxin-free workplaces Living wage Health insurance Paid sick time Healthy, affordable cafeteria & food storage options Worksite health promotion and injury prevention programs	Safety regulations and enforcement Health, safety, social services Grocery store zoning Community health centers Family recreational facilities

^*One of the strengths of the matrix is that it highlights interacting causal factors in the different phases of the health problem. For this reason, single factors may appear in more than one cell. Social factors transcend all DOHaD phases, and are combined into a single column. Factors provided are examples and are not exhaustive.

Matrix Adapted From:

Haddon W. A logical framework for categorizing highway safety phenomena and activity. J Trauma. 1972;12(3):193–207